Effect of Multimodality Chest Physiotherapy Interventions on Prevention of Ventilator Associated Pneumonia among Mechanically Ventilated Patients

Abstract

Background: Ventilator-Associated Pneumonia (VAP) refers to nosocomial pneumonia occurring 48 hours or more after initiation of mechanical ventilation (MV). Critically ill patients who is receiving mechanical ventilation may have an increased risk of VAP due to multiple factors as sputum retentions and atelectasis. Thus, different combinations of chest physiotherapy assist in the reexpansion of the atelectatic lung, confer short-term improvement in total lung-thorax compliance and expiratory flow rates, and reduce the incidence of ventilator-associated pneumonia. Objective: To identify the effect of multimodality chest physiotherapy interventions on prevention of ventilator associated pneumonia among mechanically ventilated patients. Settings: The study was carried out at the general ICUs at Damanhur Medical National institute which is classified to general ICU I (15bed) and the General ICU II (13bed). Subjects:A convenient sample of 60 adult mechanically ventilated patients from the starting day of invasive mechanical ventilation were included in the study. Tools: Two tools were used to collect the data of this study. The first tool was outcomes of multimodality chest physiotherapy assessment that was used to assess the effect of multimodality chest physiotherapy interventions. The second tool was VAP bundle observation checklist that was used to assess nurses' compliance with ventilator bundle practices. Results: The findings of the current study revealed that there was a statistically significant difference between the intervention and control groups regarding the occurrence of VAP (P= 0.001). Patients who were subjected to multimodality chest physiotherapy interventions had lower VAP rate. Conclusion: The present study revealed that patients who had a twice-daily multimodality chest physiotherapy interventions in the form of manual hyperinflation, endotracheal suctioning, patient positioning plus chest percussion and mechanical chest vibration device had a better effect on decreasing VAP occurrence as well as enhance patient`s clinical outcome than those who do not had. Recommendations: The nursing staff should use chest vibrating device with other chest physiotherapy techniques to reduce VAP in mechanically ventilated patients.

Effect of propolis mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial

“…In the study by Younes et al (2022) in Egypt, more than half of the participants had an APACHE II score less than 20, which is not consistent with the results of the present study. Their study was intervention, and those with lung damage, such as pulmonary embolism, emphysema, and uncontrolled blood pressure, were not included in the study; therefore, there was a difference in the inclusion and exclusion criteria between the two studies [53].…”

Effect of clove mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial

“…The results of this study showed that the APACHE II scores did not differ significantly between the intervention and control groups. Other studies also found no statistically significant difference between the two groups regarding the APACHE-II score [11,64]. The APACHE II score is a vital indicator of acute physiological abnormalities in patients [11,64].…”

“…Other studies also found no statistically significant difference between the two groups regarding the APACHE-II score [11,64]. The APACHE II score is a vital indicator of acute physiological abnormalities in patients [11,64]. The APACHE II score is a vital indicator of acute physiological abnormalities in patients [65,66].…”

Effect of Using Multimodality Chest Physiotherapy on Myasthenia Gravis Patients' Clinical Outcomes

“…Wang et al (2019) found that the incidence of ventilator associated pneumonia did not reduce by chest physiotherapy only, but multimodality chest physiotherapy may be an substitute respiratory rehabilitation program in ventilator patients based on individualized approach. Younes et al (2022) was also reported that using multimodality chest physiotherapy interventions had better effect on reduce risk for pneumonia, and improve oxygenation. In order to promote sputum clearance and improve oxygenation in ventilated patients, combining manual hyperinflation and ventilatory muscle endurance exercises with chest physical therapy may be beneficial (Ibrahim & Mohamed, 2018).…”